Tuesday, December 30, 2008

new beginnings

During a debrief at the end of my workterm in Botswana I was asked if I thought we were winning the war against HIV/AIDS. I didn't have a straight answer, I didn't really know how to answer the question. My job was to contribute to the cause: help the HIV/AIDS problem through the Holy Cross Hospice. Did I feel like my efforts were felt and appreciated? Yes. Do I feel the solution to this pandemic is close? No.

Being immersed in Botswana culture has enlightened me on the issues at hand. Despite the many efforts to plateau the infection rates, there is still stigma to fight and general behaviour and trend of relationships that stand in the way. No Batswana wishes others to know if they are infected and if they have yet to test, they usually don't want to know. Multiple partners are extremely common and the secret is kept to avoid any confrontation or abandonment. Gender inequality still plays a strong role in women being the hardest hit by HIV but it is getting better.

Having said that, I have seen progress and slowly we are getting somewhere. At the Hospice and other organizations like it, with the quality treatment provided, some patients are getting well enough to be discharged and start over, finding work etc. When I see this happen, I think, yes! we are winning but unfortunately the number of people we 'save' does not come close to matching the number infected each day and the number that die from it each day.

It's a sad reality, where we are at with all this. If I was asked how I think we should solve this problem in Botswana, I wouldn't have an answer. If I did, we wouldn't have the problem.

There was more to this trip than being on the front lines of HIV/AIDS. Despite the negative inuendos I may have portrayed of relationships there, I have met so many amazing people, great friends and coworkers. Batswana are a very caring and friendly people. I was also priviledged to network with people and organizations and I know I will be back, I think working overseas is a good fit for me.

My closing remarks:

There is no other way to live than in the moment. Sorry if that's super cliche but that's what I have learned most while away and I believe it whole-heartedly.

I do plan to continue to write, not sure when, where or what about but I will keep you in the know if you are interested in following my happenings.

Go siame (goodbye in Setswana)

Monday, December 15, 2008

Update

My workterm at the Hospice has come to an end. The last day was harder than expected, I was so excited about traveling I hadn't thought about saying goodbyes. Una, the hospice director, gave me the longest hug imagineable which started the waterworks. My 3 months at Holy Cross Hospice was incredible, the things I saw and people I met have changed me (for the better). I couldn't have wished for a better job placement.

Now, for the past week I have been in Zambia. A dwindling bank account forced me to reassess my traveling plans. Orinigally I was off to Mozambique but money was short and my companions were rethinking their plans as well. My new plan: revisit Vic Falls. I wanted to see the falls again once the water level had risen but my main reason for coming back was Jonathan. That's right, I have met a guy who is more than just a facebook friend once I go home. We met on my previous visit to the Falls and kept in touch during my stay in Botswana.

Jonathan is a professional kayaker and rafting guide on the Zambezi River so he knows the ropes around Livingstone

A 2-day canoe trip on the upper Zambezi started of our week, lots of sun and many hippos too close for comfort. We 'camped' on this island owned by a Scottish man named Brett who has a resort-like set up for Bundu's river trips,(Bundu is the rafting company Jonathan works for). There was an outdoor bar, dining room, kitchen and little chalet huts (so, not really camping then). I came back with a sunburn, a few blisters from paddling and a bit more respect for hippos. All in all it was a great trip.

The Flying Fox was the next day. A cable stretched across the gorge, me strapped in a harness, a running start and the feeling of flying across a river trying to reach the other side. A bit of a rush on that one.

The following day was river rafting. Jonathan was kayaking and taking pictures and I was in a raft with 4 Danish backpackers and a guide named Kevias. There are 25 rapids on the Zambezi, 24 that are runable. We were on a half day so after rapid 10 we pulled out for lunch. There were 3 class 5 rapids (highest level that are commercially run) and 1 class 6 which we had to walk around. It was so intense and exciting! I will save the details for later so not to worry anyone.

I went back to the Falls yesterday to see how different it was from a few months back. It's so impressive how much water there is and it's not even at its highest level yet.

Now, one week to go and I will be flying home for Christmas. It's bit strange because I don't feel as though it's approaching Christmas, I guess will just have to jump right in once I get home.

Trying to decide what to write about next, any ideas?

Monday, December 1, 2008

World AIDS Day

Today is World AIDS Day. There are marches all over Gaborone, a strangely comforting scene, many people supporting activism to fight this pandemic. My contribution to the cause was to lead by example. Jen (a close friend and volunteer at the hospice) and I went to get tested for HIV. I wasn't worried about the result so I assumed it would be an experience undertaken just on principle.

We arrived at the testing centre, told the front desk we would like to be tested and were asked to wait in the queue. Being the minority in the room, the only two Lekgowa, 40 Batswana stared at us as we walked in. The waiting room is daunting, you can hear people's thoughts of judgement, everyone silently questioning how you ended up here. We waited about an hour and a half.

I felt the pressure and anxiety that others feel when the test result of your life is just moments away. Jen and I talked about how we thought we would react if we were told the worst. Honestly, I don't know how I would take such heavy news and I realized this is what it was like. This is what about 25% of Batswana live through.

Counselling was required before and after the test, we decided to go through it all together. When we first met with the counsellor, we were asked a series of questions, first being for why were we getting tested. That was followed by some generic questions for statistics and then we were sent into the testing room.

The rapid HIV test is what's used through most of Botswana and it is free to everyone. There is a little prick of the finger, blood is drawn and put on two test strips.

One red stripe = NEGATIVE, two red stripes = POSITIVE

It's a test for the white blood cell count (WBCs are building blocks of the immune system which is compromised when you have HIV).

More waiting.

When the time came for our results, we couldn't help but be nervous, it's contagious there. Before our status was declared, our backround was given, some very personal questions were asked and then, the silver platter was handed to us. As we lifted the lid, my stomach turned over and then, relief. One red stripe!

My registration card was stamped NEGATIVE and as Jen and I walked out of the clinic, we smiled at each other and put on our bracelets.

My bracelet says 'ke itse seemo sa me'

...which is Setswana for 'I know my status'




do you?

Tuesday, November 25, 2008

Graduating

Last week there was a graduation for the preschool kids. The Hospice preschool is for children of our patients, providing care for them when their parents come to the centre for treatment each day. Six is the age when the kids graduate and join the kids club.

The event was outside the preschool under 2 big tents. There was a full program including a skit done by the students, a huge meal provided for everyone and a marimba band performance. The graduates were in cap and gown, so unbelievably cute! In the morning I was there to help set up everything and then I was appointed photographer for the day (the best job in my opinion). The day was a great success and concluded with dancing, what better way to celebrate.

Sunday, November 16, 2008

Tough Day at Work

I went along on home visits today. Wednesdays the patients don’t come to the centre so we make our rounds to the homecare patients who are not well enough to leave their homes. Our first patient was not at home, we were told she had been admitted to Princess Marina (the local public hospital). She lives in a one room ‘house’ with 10 children who were apparently fending for themselves while she was away.

From there we stopped in to check on another patient who had severe kidney failure and was on dialysis, this was a secondary illness to HIV. As we arrive, it looks as though they are moving out and the nurses are concerned that she has passed away. Sure enough, an elderly woman approaches the car welcoming us to sit with her and tells us that her daughter, of 43, died last week. This was one of our new patients who had just registered at the Hospice two weeks before. We shared our condolences, (well, the nurses did in Setswana and I sat there and listened) and then left to see more patients after packing up the dialysis equipment to return to the hospital.
After that visit, I was feeling a pretty low. Hospice patients have died before but today it hit me a bit harder. From there we checked in on a man who was too weak to walk, his legs had gone numb from the ARV’s. He was so thin, his legs were roughly the width of my arm and I was told to do ‘physio’ on him. I went through basic movements with him, moving his joints for him, did a few strength tests with his upper body and then it was time to move on.

We continued on to see a woman who has cancer in her larynx causing her to lose her speech, she was too weak to move in her bed. A few other patients we stopped to see had also been admitted to the hospital. I asked about a particular man who I often do exercises with because I hadn’t seen him in over a week. He is the one I mentioned before with a fused hip. He had been taken to his village to stay because the landlord said he could no longer look after him and always move him to his wheelchair. Now we don’t have any access to him for treatment and who knows if he will continue taking his ARV’s.

By now I was in a defeated mood. Not one case today showed promise and I started to question what we were doing wrong, what our services were lacking. There is always something we can improve upon but not a lot changes due to lack of resources.
The case that ended our day was a potential new client. She lived with her mother and boyfriend. Her boyfriend had taken the car and refused to get her ARV’s saying she didn’t need them (as she lay there in bed looking like a corps). The woman’s mother stayed by her side watching as her daughter wasted away, it was evident who controlled the household. The woman’s boyfriend did not understand why we were there and flat out refused our help sending us away with no access to treat the woman.

That was our last case of the day. Everyone had been through enough for the day and it was time to head back. We stopped by the hospital on the way to the Hospice and stopped in to see our patients that had been admitted. Nothing to boost our spirits, two of the three were lifeless and a nurse mentioned they may not make it through the night.

The drive back to the Hospice was silent, everyone was drained. I have never felt so helpless and hopeless. When we got back to the centre, they told me to go home early. I spilled the entire day to Jen, the other Canadian volunteer at the Hospice who has been there since July. She said that’s why they only do home visits once a week, the staff cannot face that every day.

I have been exposed to a lot of suffering during my term here but there is also recovery so I took in the bad and the good. Today there were no success stories and it was too much. I am going to leave that day here and look forward to tomorrow because it is sure to be better.

Monday, October 20, 2008

A typical day in Gabs

I woke up at 6:30am just like on any other work day, feeling tired and desperately wishing the snooze button could be hit one more time. It was already warming up outside preventing me from ever cooling down during the night after a 38 degree day before. Once I was ready for work and had grabbed breakfast, I was out the door by 7. It’s about a 10min walk to my combi stop which is right in front of the football stadium (when I say football, I mean soccer) where the Zebras play, the Botswana National Soccer team. My combi route is very popular so there are often a few that pass when full. Once I cram myself into one, the ride only lasts 10 to 15 minutes depending on traffic and how aggressive/crazy the driver is.

My day at the Hospice starts at 7:30, insanely early I thought at first, but you do get used to it (and really, what choice do I have). I greet my coworkers with ‘Dumela’ who stop to ask me how I am (each one using a different phrase in Setswana to throw me off --- this greatly amuses them as I struggle to come up with the correct response). There is a bit of down time at the beginning of the day as everyone is sorting out what needs to be done. I am often asked to do some typing or editing for any number of things (reports, proposals, resumes, and letters) but today I am going on home visits. I enjoy these days the most because I feel the most useful. I pile into the company minivan with the nurses and we head out to Old Naledi (the poorest part of the city – basically the slums). Driving through Old Naledi is an experience in itself. There are families who live in one-room shacks, there are kids running around with no clothes on, playing around old car parts or hot grills as mothers make their pap and fatcakes in their outdoor kitchen. I find it overwhelming, mostly because I don’t know what to feel when I see this. To say these people are poor is an understatement and yet, this is their way of life and they find ways to enjoy the small things.

Our first patient is a 36 year old man who is immobilized by an unexplained frozen hip, he is also suffering from other side effects from the ARV’s that are compromising his health on top of the HIV. Due to this mysterious symptom in his hip, he stays in bed most of the day and can only venture outside if someone is there to help him into a wheelchair. Once in his wheelchair, I do stretches and basic exercises with him to get his strength back trying to reach the goal of restoring basic function of his body. I help him move all his joints as best he can, as well as do strength testing, (like grip tests, flexion with resistance, etc.). I also try to make him smile by struggling with some Setswana, sometimes that helps patients just as much.

Throughout the morning, we make a few other stops, some are to recruit new patients if we have the space, others are funeral visits. I usually see about 2-4 patients on home visits who I help with ‘physio treatment’. We make it back to the Hospice in time for lunch. A variety of traditional foods is served each day for the patients and staff. The patients who come each day receive medical treatment, counselling, a social network and free, wholesome meals, for some, it’s their only meal. Lunch consists of pap (pounded maize which looks like mashed potatoes), dumplings, rice or noodles, a soup (used as a gravy), one or two of cooked spinach, beets, butternut squash, or coleslaw, and beef or chicken. Needless to say, I don’t have a big dinner when I get home at the end of the day. My afternoon is spent visiting with the patients and then planning new activities for them for the next day once they have gone home. I am currently working on putting together a library for them at the Hospice.

We ‘knock off’ at 4:30pm and I make my way to the combi stop to head home. This evening I am meeting up with the girls for dinner. The other volunteers in Gabs are Kate (from Toronto), Vanessa (from London, ON) and Iman (from Ottawa). Vanessa is my housemate and we often make dinner plans with the other girls to keep in touch. After dinner at Iman and Kate’s, we head home and watch a pirated DVD before going to bed. Since I’ve been in Bots, my bedtime is around 10pm, I don’t know if it’s the heat or the longer days at work but I am exhausted by this time. The next morning I get up and do it all over again with a few variations here and there.

On the weekends, I usually hit up a coffee shop (my only coffee of the week), and fit in grocery shopping as well. Other than that, the girls and I usually get together and do something. Last weekend we went to a concert of local jazz artists, and a friend of ours took us to see his pig farm in a village outside of Gabs.

Overall, this lifestyle is suiting me just fine.

Saturday, October 4, 2008

Holiday

It’s all about the journey.

For the last weekend in September, 4 other volunteers and myself ventured out of the country for a mini trip to Zambia. It was a long weekend in Bots for Independence Day so we all took an extra day or two off of work and started packing. The plan: Victoria Falls (Zambia), Chobe National Park for a safari (northern Botswana) and home again.

First things first, choose route and mode of travel (not as easy as it sounds). We chose the night bus, straight through to Zambia. Funny enough, Bots doesn’t really have a bus schedule or bus station, for that matter. We had to sort out where it was leaving from and when it was leaving through word-of-mouth and that’s what we based all our other plans on. We had to ask about 6 different people before we got a phone number to find out the actual times from someone else. Once it was all sorted, we made sure we were there 2 hours early to ensure a seat and a spot for our luggage then we were off. Trying to sleep on a bus like this was just short impossible (for me anyway). Picture a greyhound but the seats are closer together with less room on every side, a temperature of roughly 30 degrees, and the smell of everyone sweating. Oh yeah, good times. And we were on this bus from 8:30pm to 9am the next morning.

The traveling portion of the trip didn’t end there. We arrive at the border of Zambia, well, the border is pretty much the Zambezi River and just before that, we went through immigration. At this point we are all a bit groggy, we get into the line and notice the bus suddenly drives away. No one else seems shocked by this observation so we act like we know what’s going on. Our passports are stamped, we head outside and watch as every other passenger begins walking down the road. And we follow suit. Along our walk we find out from some friendly strangers that the bus has gone to the edge of the river to wait for the ferry and we are to cross separately and return to the bus on the other side. The riverbank was a gong show. There were trucks and buses backed up for at least 2km and a sea of people, waiting to get onto the next ferry (barge). It took us about an hour of waiting around before we got onto a barge but finally we made it across and once our visas were purchased on the other side, we headed to our hostel.

The best hostel ever! It is called Jolly Boys and I wish we could have spent more time there. It had a warm but eccentric decor to it, swimming pool, bar, restaurant, lounge area with huge pillows to veg on, gift shop (of course), pool table, and options of dorm rooms, chalets or tenting sites. They also book everything for you, tours of any kind, special dinners, you name it. Needless to say, I highly recommend it to those of you planning to travel to Africa.

Vic Falls is one of the 7 wonders of the world, so it goes without saying that it be spectacular. It wasn’t in full bloom due to the time of year (lower water levels) but it was still quite impressive. We spent 2 days exploring the falls and river by foot, boat and raft.

A few interesting encounters...

While walking through the trails around the falls, 3 Zimbabweans tried to convince us to go bungee jumping before telling us they would be our tour guides across the bridge to the Zimbabwe side of the falls. It was a short cut and they assured us they would (with a small fee) get us across the border without passports. After the attempts had failed, they tried selling us jewellery and Zimb dollars. We were, of course, not interested and wanted to be on our way so we backed out as politely as possible.

We decided to explore the top of the falls and met a local tour guide willing to lead us along the edge to get a different perspective. After some rock hopping across the drying river, we were able to look down into the gorge from the top of the falls. Incredible!

The latter half of that day we went rafting on the lower section of the river, probably the highlight of the weekend for me. It’s known as the best white water rafting in the world! I’ll save the rafting stories for another time otherwise this will get a bit lengthy. I have many pictures to go along with it as well.

Now this was only half our trip, after the falls we were off on safari. An overnight safari! So we made our way across the border, back into Bots and began the tour with a guided boat cruise on the Chobe River. After 2 hours of seeing hippos, crocs, buffalo, elephants, waterbuck, and giant lizards, we were taken to our campsite where lunch was served followed by a siesta. Later in the afternoon was the game drive which took us on a tour of giraffes, more and more elephants, lions, zebras, baboons and hyenas. I’ll save the rest of the details for the pictures to explain, they will do a better job. But I will say this, camping in the middle of all that was a little more unnerving than expected. We fell asleep listening the elephants trumpeting close by and hyenas walking through our campsite, quite the experience.

Alright, I will leave it there. If you have made it this far, thanks for reading. There’s so much more I could add but we will save that for a later date.


Ciao

Sunday, September 14, 2008

Adapting...........or trying to

There are many misconceptions about Bots (and Africa for that matter) and it’s starting to get to me how ignorant we can be. This place is not a dead end and it shouldn’t be called the ‘Dark Continent’ because it is the most colourful place I have ever seen.


Saying ‘hello’ is a start. This is quite different from home. ‘Dumela’ is the equivalent in Setswana (the main language in Bots besides English). If you are addressing a woman you say, “Dumela mma” and a man, “Dumela rra”. People here take the time to say ‘dumela’ to each other and stop to further ask how you are, and how your family is. Being late for work, appointments, and meetings is the norm here, the pace is much slower and laid back (it’s called Botswana Time).


Bots landscape is dry but not quite a desert. There are floral trees everywhere as well as papaya, lemon and palm trees. This area is called the shrub lands and the Kalahari Desert is just west of us so it’s very hot. It’s spring right now and soon it will be summer (which is supposed to be around 40+ deg), and I know it sounds crazy but I could get used to this heat.


Batswana people are extremely friendly, but at the same time, I am a foreigner and there are those that just stare. Being a minority is an interesting experience, truthfully, uncomfortable at times. I think feeling alienated at times is healthy, it’s like a deserved slap across the face, reminding me that I shouldn’t take my way of life and my comfort zone for granted. The other girls from Canada, who are also volunteering in Bots, are adjusting at their own pace as well. We hit it off the first time we met and have had a few intriguing discussions about our initial impressions of the country and the way things work here. Some of us are much more uncomfortable with the way things operate here than others. We are coping the best we know how with what we don’t understand, and our small group of 4 works well to support each other.



Gaborone (pronounced Hab-or-on-ee) is the capitol of Bots and is the city I live in. It’s a city about the size of Ottawa and has such character. Weirdly enough, my first day here I was taken to a mall, and yes, it’s very similar to the malls back home. Gabs has 4 malls, 2 movie theatres and many international restaurants, (I can even get sushi here)! I was shocked. I wasn’t sure what to think but I know I wasn’t expecting all these luxuries (if you can call them that), to be at our fingertips. I soon learned that Bots is fairly new (became independent in 1966) and since then, has been hugely influenced by the western world. Now having said that, there are parts of the city that will utter you speechless, I say speechless in the context of being so horrified from witnessing the way of life, or lack thereof. Not surprisingly, Gabs is filled with HIV and AIDS (every 1 in 3 people is infected), and yet, you don’t see people sick and falling over in the street. There are awareness campaigns all over but it is not discussed among the people. Stigma is the biggest contributor to the problem here, everyone wants to hide it because they will be looked down upon if exposed. From the outside looking in, people here seem happy, they are enjoying life and I believe most of them do, despite the continued, raging current just below the surface. I think most are doing the best with what they have, which isn’t much in some cases.


While I’m here, I will be working at the Holy Cross Hospice (http://www.holycrosshospice.org/). This organization’s mandate is to help HIV/AIDS patients who are terminally ill as well as families affected by it. They run programs and workshops on positive living, HIV/AIDS awareness and prevention, they offer counselling and medical services, as well as provide them with 2 meals a day. I have only been to work 2 days so my opinion and full understanding of their operation is limited but I have met some of the patients who seem to be close to healthy which is encouraging because I was told they were near death when referred to the hospice. I still don’t know where I will best fit in at work but I was warned it takes time to sort that out. I’m encouraged to initiate activities for the patients and come up with ideas for projects I can work on during my stay. I will get to shadow the social workers while I’m there but as far as my job description and experience, from what I understand, it is what I make it.


So far I would describe this adventure as challenging and exciting, and there’s so much more to come!


Until next time.....


(pictures still to come)